Headaches hurt! They throb, they ache, they can cause nausea, vomiting, dizziness, even loss of vision and numbness on one side of the face or body.

They can feel like an intense muscle spasm that just will not go away or like a clamoring, contentious drum roll that's repetitive and intolerable, crowding out everything but the pressure vibrating inside the head.

For some people, headaches go well beyond occasional discomfort to seriously debilitating pain and total incapacitation.

"My head feels like it is in a vise that someone is continually tightening. Just lifting my head up or moving it hurts. Sometimes one side of my face feels numb and I lose my vision. I am usually nauseous and I sometimes vomit. It can get really scary. All I want to do is go into a dark room and lie down and not move, and to isolate myself from all sounds and light."

Rioux suffers from chronic migraines. "They run in my family," she says. "And, I've had them since I was a teenager."

There are 150 diagnostic headache categories. More than 45 million people in the United States suffer from one or more types. In fact, headaches are quite common according to medicinenet.com. Up to 90 percent of adults have had or will have a headache at some point in their lives. And, they are costly in financial terms as well as in human suffering. Headacheanalyzer.com estimates that migraine headaches alone cost employers nearly $13 billion dollars annually.

"Headaches result in more days of work lost than any other medical problem causing disability," says neurologist Bruce Abbott, Director of Neurology and Sleep Medicine at Southcoast Brain and Spine Center in Dartmouth. "It is the No. 1 reason patients visit a doctor."

"Up to 90 percent of people with migraines have a family history of them. Somewhere in their genetic tree there is a relative with migraine," says neurologist Michael Markowski, DO, of Hyannis, Stroke Director at Cape Cod Hospital and Vice Chair, General Section of the American Academy of Neurology.

"If you have a relative with migraine, your risk of having it is three times greater than that of the general population."

It is thought that people with migraines inherit the tendency to be affected by certain triggers, such as emotional stress, fatigue, lack of sleep, bright lights, loud noises, changing weather conditions and menstrual changes. Caffeine, specific chemicals like perfumes or preservatives in foods like aged cheese and luncheon meats can also trigger headaches, as can wine, artificial sweeteners andmonosodium glutamate.

Markowski says that about 25 percent of people with migraines experience visual disturbances and other neurological symptoms called auras, which act like warning signals that a migraine headache is imminent.

Lexi Maddox, 18, of Cotuit, says that migraines run in her family and that she knows when she is about to get one.

"I know a headache is coming because I see spots, lose my appetite and sometimes get dizzy or vomit."

Children are not immune to headaches. The National Institute of Neurological Disorders and Stroke says that two out of three will have had a headache by the time they are 15.

Maddox says she was 14 when she had her first migraine.

"I had had headaches before, but this one was different. I began to see spots and was really nauseous and then the pounding in my head began."

For some women, migraines are influenced not only by heredity, but by the rise and fall of hormonal levels.

Nansea Taylor, 57, of Marstons Mills, says that her father and sisters have migraines and recalls that her first migraine was when she was 10 years old.

"After that I got migraines several times a month. The pain was excruciating, skull cracking. You absolutely cannot function. You feel as if your head is about to explode. Sometimes I was vomiting so much, I needed medical attention. After I had my son, the headaches were less frequent but more severe. I sometimes had paralysis on one side of my face. When I began menopause my headaches became less and less frequent. And, today, I am post menopausal and, for the most part, headache free."

Markowski says "for some women migraines tend to occur at the beginning of the menstrual cycle because of a relative drop in estrogen at that time which can trigger the headaches."

The National Institute of Neurological Disorders and Stroke suggests that keeping a headache diary helps to identify potential triggers. Included in the diary should be notations about when a headache starts, how long it lasts and what treatment provided relief. Recent foods eaten, missed meals, how well one slept the night before, current emotional stressors and activities which may have provoked the headache, as well as any new medications and how long they have been taken, should also be noted. The goal is to find a pattern to the migraines so that offending environmental and other triggers can be avoided.

"The most effective class of medications for migraines are triptans, which are specific for the mechanism of migraine and must be prescribed by a physician," says Markowski. "The sooner these medications are taken after the onset of the migraine/aura, the more effective they will be."

Markowski suggests non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil) and Naprosyn (Aleve), acetaminophen (Tylenol), Excedrin and the anti-nausea medications Reglan and Phenergan as a second line of medications, but says they are not as specific to migraine or as helpful as the triptans.

"Narcotics should be avoided," Markowski says, "as they are habit forming, and not specific for the mechanism of migraine or other headaches. Butalbitol, the active ingredient in the medications Fiorinal and Fioricet, can also be habit forming and should be avoided."

Markowski adds that "medication can be taken on a daily basis to decrease the frequency of migraines, but that is only recommended if there are two or more debilitating migraines a month. For most people, preventive medication is not required."

Alternative treatments are also available. Markowski says that none are as effective as prescription medication, but that they do have fewer side effects. He says that vitamins such as riboflavin (B2), magnesium and the supplement Coenzyme Q10 may be helpful as well as the herbs feverfew and butterbur. Acupuncture and biofeedback may also be useful approaches.

A headache can, on rare occasions, be accompanied by red flags, other symptoms that signal the need to see a doctor.

Markowski says that "when the headache is unlike any other you have ever had, when it is sudden and severe or when it is of maximum intensity at its onset, you need to see a physician. Other red flags include those headaches that are associated with fever, stiff neck or confusion, or neurological symptoms such as weakness, numbness or changes in speech or vision. These symptoms, as well as any following a head or neck injury, require evaluation by a doctor. In addition, progressive headaches that are precipitated by coughing, exertion or straining or occurring in people with a history of cancer or HIV must also be evaluated"

Tension-type headaches are one of the most common types of headache people experience.

"They tend to affect women slightly more than men," says Abbott, "usually begin in adolescence and reach peak activity in the 30s. They do not have a strong hereditary connection or auras and have not been linked to hormones," he says.

Symptoms include non-throbbing tightness and pressure that evolves into pain at the upper neck or back of the head, a feeling of pressure that circles the head like a tight band and mild to moderate pain that affects both sides of the head. It is not aggravated by physical activity.

Tension headaches are divided into episodic or chronic categories. The National Headache Foundation says that episodic headaches involve attacks occurring less than 15 days apart per month and lasting from 30 minutes to seven days. Chronic headaches are daily and continuous and are more difficult to treat.

"Most people experience an episodic headache at one time or another," says Abbott. "They can arise from a variety of causes, such as the sinuses or muscle tension related to stress, and are usually effectively treated with over-the-counter medication."

Abbott says that "chronic headaches are resistant to treatment and may be due to numerous causes, which may all be occurring at the same time. They don't respond to simple medication and result in numerous visits to doctors and to hospital emergency departments."

When headaches are chronic, and "two or three headaches are going on at the same time, neither the patient nor the doctor can tell the headaches apart," says Abbott. "All of the headaches must be treated to get comprehensive relief. Each specific headache is made better by treating the related problem, so that if there is a tension headache accompanied by neck pain, treatment of the neck may substantially reduce the pain of the tension headache."

Unfortunately, medications only treat the symptoms. Lifestyle changes such as stress reduction, regular exercise, getting plenty of sleep and avoiding dietary triggers can be effective long-term strategies to treat the causes of tension-type headaches and to lessen the pain and frequency of them. Physical therapy to address neck spasms, biofeedback, cognitive behavioral therapy, acupuncture and relaxation techniques such as meditation and yoga can also be useful.

Greg Saucier, 23, of New Bedford, says that his headaches began when he was 13 or 14 years old.

"They come once or twice a week, sometimes every other week and feel as if there is a band tied tightly around my forehead. They are moderately painful, but I can treat them with over-the-counter medication if I need to. If I get a good night's sleep, I'm usually OK in the morning."

Abbott says that medical treatment of tension-type headaches includes the use of over-the-counter medications like ibuprofen, acetaminophen and Naprosyn and adds that prescription preventive medications are also available.

"While pain relievers are helpful in improving headache pain, they must be taken with caution because some are highly addictive and most can actually make headaches worse if they are overused or misused," says Abbott. "Exceeding label dosage instructions or not following a doctor's advice can lead to rebound headaches, which can make an already painful condition much worse."

A rebound headache sounds as if it's the result of a bad relationship, and that is what it is.

When pain medication wears off, people may experience a withdrawal reaction because the body has gotten used to it. That may prompt them to take more medication, which leads to another headache and another round of medication. It becomes a cycle that can induce chronic daily headaches that are severe.

Why? Because pain reliever overuse appears to interfere with brain centers that regulate the flow of pain pathways and receptors within the brain that perceive pain. If the message is not getting through, the headache pain remains or, sometimes, gets worse.

"Medication overuse-caused rebound headaches are among the most common headaches a neurologist sees, as common as tension or migraine headaches," says Markowski. "We know that five doses per month of Fiorinal or Fioricet; narcotics taken eight days per month; Triptans taken 10 days per month; and NSAIDS like Tylenol and Excedrin taken 15 days per month can lead to rebound headaches. They will transform a previously episodic headache into a chronic daily one. "

Rebound headaches are commonly present daily upon awakening and persist all day. The pain is diffuse, achy and covers the entire head. The headache improves after medication is taken, but returns a few hours later after the medication has worn off. The treatment is detoxification; discontinuing the medication entirely or gradually reducing the dosage.

"Patients have to be willing to accept the fact that their medication is the cause rather than the cure of their chronic daily headaches," says Markowski.

Because it is sometimes difficult to be certain of the root causes headaches, they can be frightening as well as painful. When in doubt, it is always important to have those symptoms evaluated by a health care professional. But, it is reassuring to note that although some headaches can mimic the symptoms of serious illness, most are actually benign.

"The vast majority of headaches are benign and self-limited," says Markowski. "They are not typically reflective of any larger brain disorder or worrisome pathology such as a tumor, bleed or stroke."